Glycosuria
• I. Diabetic : in DM
• II. Non-diabetic:
– Alimentary glycosuria – partial gastrectomy,
excessive sugar ingestion
– Renal glycosuria - low renal threshold,
pregnancy, after anaesthesia
– Endocrine- hyperthyroidism, pancreatitis,
acromegaly, Cushing syndrome
– Liver disease
– Intracranial injury
– Starvation
C. KETONE bodies
• Ketone bodies are intermediate products of fat
metabolism & include acetone, acetoacetic acid
& β hydroxyl butyric acid
• Ketonuria - diabetic ketoacidosis, starvation,
glycogen storage diseases, eclampsia, severe
dehydration states, febrile states & after general
anaesthesia.
• Tests: 1. Rothera’s- acetone, acetoacetic acid
2. Gerhardt’s – acetoacetic acid
D. BILE SALTS
Hay’s test:
Principle: Bile acid lowers the surface tension
of fluids in which they are contained.
E. BILE PIGMENTS
• Principle: Bile pigments are oxidized by acids
forming a series of coloured derivatives of
bilirubin. eg biliverdin (green), bilicyanin (blue),
& choletelin (yellow).
• Gmelin’s Test
• Harrison Fouchet test
BILE SALTS AND BILE PIGMENTS
BILE PIGMENT UROBILINOGEN
OBSTRUCTIVE
JAUNDICE + –
HEPATOCELULLAR
JAUNDICE + +
HEMOLYTIC
JAUNDICE – +
F. BLOOD
• Presence of blood may be in the form of intact
RBC’s (hematuria) or hemoglobin
(hemoglobinuria).
• Benzedine test:
Urine is centrifuged . The sediment is mixed
with equal volumes of the reagent (saturated
solution of benzedine in glacial acetic acid to
which equal quantitiy of hydrogen peroxide is
added)
Result: Blue color indicates a positive test
Hematuria:
• Pyelonephritis
• Urinary calculi
• Renal tuberculosis
• Tumours of kidney & urinary tract
• Sulfonamides & salicylates
Bleeding can occur high in the kidney & renal pelvis
( urine appears smoky brown due to hematin) or in lower
urinary tract (bright red urine).
Hemoglobinuria:
Disintegration of RBC’s within the circulation with
excessive liberation of Hb
When free hemoglobin d/t hemolysis is >150mg% in
plasma, it is excreted by the kidneys
(i) black water fever , clostridial infection
(ii) severe burns
(iii) hemolytic transfusion reaction
(iv) autoimmune hemolytic anemia
(v) PNH
(vi) sulfonamide & phenacetin administration
MICROSCOPIC EXAMINATION
1. Cells
(a). Pus cells
• Normal range is 2-5/HPF
• Pyogenic infection of
urinary tract and genital
tract
• Glomerulonephritis
• Kidney infarct
MICROSCOPIC EXAMINATION
(b). Red cells:
Pale yellow refractile
discs, & disintegrate on
addition of 2% acetic acid
Normally an occasional
red cell may be present.
Significant numbers
indicate hematuria.
MICROSCOPIC EXAMINATION
(c). Epithelial cells:
Originate from any site in
the genitourinary tract
Normally 3 – 5/ H.P.F.
(a) tubular
(b) transitional
(c) squamous cells
CASTS
• Cylindrical structures with parallel edges, formed by
precipitation of proteins (Tamm Honsefall protein) within
DCT & collecting tubules
• Associated with pathological change in kidney
a) Hyaline - fever, anaesthesia, GN, nephrosclerosis,
exercise
b) Epithelial – acute GN, kidney infarct
c) Granular – chronic GN, nephrosclerosis
d) Waxy - chronic nephritis, NS, Anuria, prolonged oliguria
e) RBC & WBC cast – pus cell cast
f) Pigment – blood, hemosiderin, bile, melanin
CRYSTALS IN URINE
Normal 1-3 per lph
Crystals in acid urine
Uric acid crystals
Urate crystals
Calcium oxalate
CRYSTALS IN URINE (Cont.)
Crystals in alkaline urine
Ammonium magnesium phosphates
Calcium carbonate
Ammonium biurate
CRYSTALS IN URINE (Cont.)
3. Abnormal crystals
(a) cysteine
(b) leucine
(c) Tyrosine
PARASITES IN URINE
Trichomonas vaginalis
Microfilaria in chylous urine
Ova of schistosoma hematobium
Hooklets or Scolices of E.granulosus
BACERIOLOGICAL EXAMINATION
For pyogenic organisms
For M. tuberculosis
SPECIAL TESTS
CYTOLOGICAL EXAMINATION FOR CANCER
HORMONES IN URINE
Diseases of ovary, adrenals and pituitary
Diagnosis of pregnancy (HCG level )
Hydatiform mole and choriocarcinoma (HCG level)
DIP STICKS/ REAGENT
STRIPS
Commercially available
strips impregnated with
various reagents, for
easy & rapid testing of
various abnormal
constituents of urine.
URINE REPORT
Name: Regd no:
Age: Sex: Time of collection:
Chief complaints:
PHYSICAL EXAMINATION
Appearance-Colour,clarity :
Odor :
Volume :
Specific gravity :
CHEMICAL EXAMINATION
Reaction :
Proteins :
Sugar :
Ketone bodies :
Bile salts and pigments :
Urobilinogen :
MICROSCOPY
RBCS :
PUS CELLS :
EPITHELIAL CELL :
CASTS :
CRYSTALS :
OTHER FINDINGS :
IMPRESSION
